Pharmacy Hub

Ashcroft Protocols at a Glance

NOACS

By Pardip Sandhu

Currently our patients are part of shared care – meaning some are managed by hospital and some by us. They need to be separated out with a separate recall. If there is a chronic disease ok to be with this. But important it is separate because some need 6m/3m recall so will need recall separate.  The letter and info they receive needs to be different.

  1. New pt initiated on NOAC (letter/discharge summary/task).
    In SystmOne, click NOAC by Junaid template
  2. Fill in p1 starting NOAC (ignore pt questionnaire)
    Guide to adding a recall
    • If the pt needs 12mly bloods and there is a chronic disease recall in place add the recall to existing recall
    • Highlight chronic disease recall and click amend recall type in ‘NOAC recall- FBC LFT and U&E 12mly
    • If there is no chronic disease recall add a NOAC recall- type in ‘12mly fbc LFT and U&E’
  3. Medication review for a patient on NOAC (page 2 of the template)
    • Do HASBLED score The BP and alcohol intake would have been inputted by PN by nurse
    • Telephone review for a medication review
    • Supersede recall
  4. Any queries task Dr Pardip Sandhu

Mental Health

By Liz Hamblin

 

  1. Pharmacy hub receives a discharge summary with a new antipsychotic medication.
  2. Look at patient record if the patient is on a mental health register- if yes, do nothing.
  3. If not on a MH register- send task to nurse admin to add  note to existing recall/new recall for bloods and BP

FRACTURES, FRAX & Osteoporosis

By Ramesh Mehay

Go into patient records

WHEN YOU GET A FRACTURE LETTER IN A PATIENT >AGE 50

  • Click TEMPLATES – Ashcroft on left hand menu
  • Click FRAGILITY FRACTURES BY RAMESH
  • Click the little doctor icon at top of template
  • Go through page 1 – INITIAL ASSSESSMENT
    • Work out whether this is a fragility fracture – may need to ring patient and ask if the fracture was a result of mild impact. (For example, falling down two steps shouldn’t cause a fracture!).
    • Use Sheffield Frax Tool link to help you; https://www.sheffield.ac.uk/FRAX/tool.aspx?country=1
    • If yes, refer for DEXA scan – do the referral after you have filled in the template
    • If you do refer, please arrange a review slot for yourself to look at the scan results and advise the patient.

WHEN THE SCAN COMES BACK

  • Go back into template.
  • Click on page 2 – BONE SCAN RESULT & DIAGNOSIS
  • Only fill in what you can. Don’t worry about anything that you can’t. It should be obvious from the DEXA report.

Then click on page 3 – TREATMENT

  • What treatment does the scanned letter advise?
  • If diet and exercise – please print out diet/exercise sheet for osteoporosis
  • Start Ca Vit D & bone sparing agent (Alendronate) if recommended on the letter. Follow NICE guidelines if unsure.
  • Arrange repeat scan 2 yearly